A controlled, parallel, cluster-randomized trial of community-wide screening and treatment of asymptomatic carriers of Plasmodium falciparum in Burkina Faso.
Malar J
; 12: 79, 2013 Feb 27.
Article
em En
| MEDLINE
| ID: mdl-23442748
ABSTRACT
BACKGROUND:
In malaria-endemic countries, large proportions of infected individuals are asymptomatic, constituting a reservoir of parasites for infection of newly hatched mosquitoes. This study evaluated the impact of screening and treatment of asymptomatic carriers of Plasmodium falciparum.METHODS:
Eighteen villages were randomized (11) to study arms and inhabitants participated in four community screening campaigns three before the rainy season ~1 month apart, and the fourth after the rains at ~12 months. On day 1 of campaigns 1-3, asymptomatic carriers in the intervention arm were identified by rapid diagnostic test and treated with artemether-lumefantrine. Outcomes were symptomatic malaria with parasite density >5,000/µL per person-year in children < 5 years and change in haemoglobin between days 1 and 28 of campaign 1.RESULTS:
At 12 months, the number of symptomatic malaria episodes with a parasite density >5,000/µL per person-year in children < 5 years was not significantly different between arms (1.69 vs 1.60, p = 0.3482). Mean haemoglobin change in asymptomatic carriers during campaign 1 was greater in the intervention vs control arm (+0.53 g/dL vs -0.21 g/dL, p < 0.0001). ANCOVA demonstrated that mean asymptomatic carriage at the cluster level was lower in the intervention vs control arm at day 1 of campaigns 2 (5.0% vs 34.9%, p < 0.0001) and 3 (3.5% vs 31.5%, p < 0.0001), but showed only a small difference at day 1 of campaign 4 (34.6% vs 37.6%, p = 0.2982). Mean gametocyte carriage was lower in the intervention vs control arm at day 1 of campaigns 2 and 3 (0.7% vs 5.4%, p < 0.0001; 0.5% vs 5.8%, p < 0.0001), but was similar at day 1 of campaign 4 (4.9% vs 5.1%, p = 0.7208).CONCLUSIONS:
Systematic screening and treatment of asymptomatic carriers at the community level did not reduce clinical malaria incidence in the subsequent transmission season, indicating greater levels of parasite clearance are required to achieve a sustained impact in this setting.
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Base de dados:
MEDLINE
Assunto principal:
Portador Sadio
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Programas de Rastreamento
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Malária Falciparum
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Técnicas de Laboratório Clínico
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Antimaláricos
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Incidence_studies
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Prognostic_studies
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Screening_studies
Limite:
Adolescent
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Adult
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Aged
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Aged80
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
País como assunto:
Africa
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article